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Volvulus is a topic covered in the 5-Minute Emergency Consult.

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  • Axial twist of a portion of the GI tract around its mesentery causing partial or complete obstruction of the bowel
  • Often associated with other GI abnormalities
  • In pediatric setting, infants typically involved:
    • Abnormal embryonic development
  • Can be precipitated by pathologic distention of the colon
  • Blood supply may be compromised by venous congestion and eventual arterial inflow obstruction, leading to gangrene of the bowel and potential infarction


  • 3rd most common cause of colonic obstruction (10–15%) following tumor and diverticular disease
  • Epidemiology:
    • 0–1 yo: 30%
    • 1–18 yo: 20%
    • Over 18 yo: 50%
  • Often associated with other GI abnormalities
  • Cecum (52%):
    • More common in young adults, < 50 yr old
    • Due to improper congenital fusion of the mesentery with the posterior parietal peritoneum, causing the cecum to be freely mobile in varying degrees
    • Associated with increased gas production (malabsorption and pseudo-obstruction)
    • Can be seen in pregnancy and after colonoscopy
  • Sigmoid (43%):
    • More common in:
      • Elderly
      • Institutionalized
      • Chronic bowel motility disorders (Parkinson)
      • Psychiatric diseases (schizophrenia)
    • Due to redundant sigmoid colon with narrow mesenteric attachment
    • Associated with chronic constipation and concomitant laxative use
  • Transverse colon and splenic flexure (5%)
  • Gastric volvulus (rare) associated with diaphragmatic defects

Pediatric Considerations
  • Midgut volvulus:
    • Due to congenital malrotation in which the midgut fails to rotate properly in utero as it enters the abdomen
    • Entire midgut from the descending duodenum to the transverse colon rotates around its mesenteric stalk, including the superior mesenteric artery
    • Common in neonates (80% <1 mo old, often in 1st week; 6–20% >1 yr old)
    • Males > females, 2:1
    • Sudden onset of bilious emesis (97%) with abdominal pain
    • May have previous episodes of feeding problems/bilious emesis
    • In children >1 yr old, associated with failure to thrive, alleged intolerance to feedings, chronic intermittent vomiting, bloody diarrhea
    • Constipation
    • Mild distention, since obstruction higher in GI tract
    • May not appear toxic based on degree of ischemia

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Rosen, Peter, et al., editors. "Volvulus." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/all/Volvulus.
Volvulus. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/all/Volvulus. Accessed April 23, 2019.
Volvulus. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/all/Volvulus
Volvulus [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/all/Volvulus.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Volvulus ID - 307280 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/all/Volvulus PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -